Our final thoughts...

As we reach the end of the course, we have developed an understanding of many different biotechnologies and their applications to modern medicine. It is often difficult, however, to recognize the fact that many such resources do not necessarily have counterparts in the developing world. One clear example is the lack of biopharmaceuticals and drugs that are the mainstay of healthcare in many Western nations. It is difficult to fathom the problems we would face if the drugs and vaccines we take for granted were suddenly out of reach, but for many people, this is the harsh reality. This disparity even extends to substitutive medicine through cervical cancer screenings, prosthetics, and treatment for end stage renal disease. Finally, a recent innovation in health, medical tourism, further augments the gap in availability of resources not only between nations, but also within nations.

Despite the vast need for drugs and vaccines, there are many barriers to introducing new pharmaceuticals into developing nations. The obstacles range from buying the drugs, to funding basic research, to ensuring that drugs developed in the West work with the genetic make-up of people in developing nations. The wide variety of problems involved with taking pharmaceuticals to the developing world makes it seem like no solution can address all of the associated complications, but great strides are being made to help people who need such resources most.

There exist many individuals and organizations prepared to exert their efforts to help reduce some of the global healthcare crises: whether it is Bill Gates and GAVI, universities and UAEM, or the United Kingdom, individuals are beginning to take on the overwhelming issues facing third world nations. Much of that effort includes funding the great costs that healthcare workers face when implementing important, yet specific, treatment and prevention programs; however, these organizations also help provide a broader infrastructure that will be crucial in the coming decades when the fruits of future discoveries need to be provided quickly and efficiently.

One specific example of a funding/infrastructure initiative is the United Kingdom’s promise to purchase 300 million doses of any future malaria vaccine. Additionally, a comment we received from blogger Jessica Pickett gave a little background on another concept of “pull mechanisms,” which have been introduced in order to provide research incentives for pharmaceutical companies. These companies would otherwise not focus on drugs for such underserved populations because they tend to be less profitable than drugs targeted for wealthier populations; universities and other private investors like Bill Gates, on the other hand, can stand up to those companies and provide incentives to aid deserving nations.

Even with the increased funding, the many contributors have choices to make in terms of what to fund. There are essentially two schools of thought on alleviating epidemic and disease in the developing world: prevention and treatment. The United States and other groups continue to struggle to find the perfect balance between both options so that the money they provide can go a further distance. Obviously, these individuals want to do all that is possible to treat and provide relief for those currently afflicted; but at the same time, the costs to treat many of these diseases will skyrocket if preventative measures are not employed. Increased funding also seems to create a problem that is not so obvious: a few nations, like Sierra Leone, won’t allow certain pharmaceuticals into their borders. In this case, allowing opiates related to palliative into the nation will create the increased risk of addiction epidemics and some government officials are not ready to take on the related problems.

Even with the help of such external forces, developing countries are still behind in acquiring the biotechnological developments that save and improve the lives of millions of residents in the developed world. This is mainly because developing countries simply do not have the money or the resources to invest in the devices, pharmaceuticals and manpower that come with new procedures. Some developing countries are, slowly but surely, getting some of the technology that by now seems old to us, such as dialysis for end stage renal disease. But in other places, where waiting is simply not an option for sick or injured residents, people have come up with ingenious ways to use locally available materials to create devices and procedures that are sometimes just as successful as their First World equivalents, especially related to prosthetics and cervical cancer screenings.

Of the developments this blog discusses, the new cervical cancer screening procedure is by far one of the most exciting. Not only is it cheap and effective, and thus perfect for developing countries with little money to spend on fancy machines and medicines, but also it is preventative, which saves the countries more money in the long run; and more importantly, it saves millions of women from life-threatening cervical cancer. This is one of the first steps in the right direction for biotechnology as it makes its way into the developing world, and other scientists and doctors should follow the steps of Dr. Blumenthal in coming up with new and inexpensive ways to treat diseases, or better yet, catch them before they take off.

Surprisingly, the emerging practice of medical tourism puts some of the developing world onto nearly equal footing as the developed . Primarily, there is much ambiguity in the term “medical tourism” because the phrase actually encompasses two very separate ideas. The older concept refers to the practice of Western trained doctors traveling to developing nations in order to serve overlooked populations; the other definition is quite the reverse, as Western patients travel to the developing world for significantly more affordable medical care. Each phenomenon presents its own set of problems and intricacies, but the developing world is greatly impacted by both.

The former trend, while seemingly altruistic, actually disrupts the normal flow of a developing community because the visiting doctors often know very little about the locality’s culture, history, practices, and even language. Antibiotic resistance, allergic reactions, and disjointed care are all hallmarks of medical care provided by traveling foreign doctors; the most common response by frustrated native medical professionals questioning the intentions behind such tourism is, “Who exactly is it that are you trying to help?”

Medical tourism in the other and more popular sense, however, is picking up momentum as doctors in the developing world run to embrace it; the hotel quality five-star accommodations of a lot of medical centers in countries like India and Thailand are widely touted, along with the professionalism of the largely Western-trained medical staffs and the tourism sightseeing perks thrown into the more affordable deal. This situation is ideal for many of the uninsured and chronically ill patients that the United State’s health care system has left behind, and even employers using private insurers hope to save many dollars by sending employees abroad for the routine and non-elective procedures that are substantially cheaper elsewhere.

On the other hand, little is said about the behind-the-scenes chaos that the tourist destinations experience as a consequence of Western enthusiasts. Countries like India that already spend very little money in the public health sector now channel government funding towards attracting lucrative foreign patients; poor Indians then find it even more difficult to access and afford their critical health needs.

Finally, despite all of the media noise, medical tourism is not exactly popular in the United States – yet. Only about 150,000 Americans go abroad for medical attention, and for those wanting to increase the practice, there are many drawbacks. There is little legislation regulating medical care in other nations (which is one of the reasons that care is cheaper abroad in the first place), so questions regarding post-trip complications, relapses, and botched care have to find their place in the list of priorities before the practice will become very widespread. Even then, there may be strong resistance from the overlooked poor public of destination nations.

Biotechnology is thus responsible for the great strides that have been made in improving health in developed nations. With the efforts and energies of many international groups and with great determination from the developing world itself, the past decade has seen the realization of analogous end points in third world nations, albeit utilizing different approaches. As scientific advances are introduced into the developing world, and as the developing world even confers services to the international community, nations hopefully will be able to retain their cultural identities; only then can the nations be deemed truly healthy.